Tag: statistics

Mil Med. 2025 Aug 19:usaf407. doi: 10.1093/milmed/usaf407. Online ahead of print.

ABSTRACT

INTRODUCTION: The Defense Health Agency directs that military Medical Treatment Facilities provide Patient-Centered Medical Home (PCMH) services within its Internal Medicine and other Primary Care clinics. Development and documentation of self-management goals for chronic diseases within the electronic medical record (EMR) is a PCMH accreditation standard through the Joint Commission. This quality improvement project aimed to implement a structured approach to creating and documenting SMART (Specific, Measurable, Achievable, Relevant, and Time-bound) goals for patients with Type 2 Diabetes Mellitus (DM) in a military-affiliated Internal Medicine clinic. Although SMART goals have demonstrated clinically meaningful reductions in hemoglobin A1c (HbA1c), the effects of SMART goals on patient perceptions of their health and self-management of their DM have not been fully studied.

MATERIALS AND METHODS: This study voluntarily enrolled 62 patients aged 19-90 with DM and HbA1c >8% (64 mmol/mol) within the previous 6-month period from a military-affiliated Internal Medicine clinic. Exclusion criteria included patients following with a subspecialist for DM management. Enrolled patients developed and discussed SMART goals with their physician using a standardized goal-setting tool for self-management of their DM. These goals were documented in the EMR for longitudinal follow-up between patients, physicians, and the clinic care team. HbA1c and patient self-reported health perceptions were evaluated before and after 3 months of participation in this intervention. Data analysis used a 2-tailed paired samples t-test. The study protocol underwent Institutional Review Board examination and was determined not to constitute research.

RESULTS: Of 62 patients enrolled, 36 completed post-surveys and were included in the statistical analysis. Results showed a statistically significant reduction in HbA1c levels, with a mean decrease from 9.18% (77.2 mmol/mol) to 7.84% (62.7 mmol/mol) (P < 0.001). Patient-reported perceptions of their health, goal-oriented behaviors, perceived ability to influence health through lifestyle changes, and responsibility for self-management of their DM did not change significantly.

CONCLUSIONS: This quality improvement project further highlights the importance of self-management goals in improving biomedical outcomes and disease management markers. Despite a significant improvement in HbA1c, no changes were observed in patient-reported health perceptions. Overall, patients indicated high adherence and positive feedback with this intervention. The goal-setting tool and standardized documentation strategy as implemented are a viable strategy for satisfying a PCMH accreditation standard. Future studies could address limitations such as single-site design, response rates, and review specific effects on perceptions with the use of validated survey instruments. Similar self-management interventions can be applied to other chronic diseases where daily lifestyle choices influence outcomes.

PMID:40829048 | DOI:10.1093/milmed/usaf407

Chaos. 2025 Aug 1;35(8):083127. doi: 10.1063/5.0279141.

ABSTRACT

We develop a rigorous mathematical framework to determine the optimal inter-layer edge configurations that maximize synchronizability in two-layer chain networks-an area previously limited to empirical approaches. Departing from prior work relying on numerical simulations, we analytically prove that synchronizability is maximized when inter-layer edges are placed (i) at the chain’s midpoint (single-edge case) and (ii) at the one-quarter and three-quarter positions (dual-edge case). We also compute the coupling strength thresholds and further conjecture the optimal placement pattern for an arbitrary number of inter-layer edges, supporting this hypothesis with extensive numerical validation. These results bridge spectral graph theory and network topology design, offering principled guidelines for engineering interconnected chain-like systems, such as supply chains, information dissemination, and epidemic spread.

PMID:40829032 | DOI:10.1063/5.0279141

Am J Audiol. 2025 Aug 19:1-17. doi: 10.1044/2025_AJA-25-00066. Online ahead of print.

ABSTRACT

PURPOSE: The Minimum Speech Test Battery-Version 3 for adults (MSTB-3) was released in 2024 as an evidence-based, streamlined test battery for pre-operative determination of candidacy and postoperative assessment of adult cochlear implant (CI) performance. A survey was dispersed to examine clinicians’ understanding and adoption of the new protocol and gain clinical insights on its implementation.

METHOD: A link to a 32-question survey was distributed to audiologists via e-mail and social media platforms, collecting responses from 307 participants practicing in various settings. The survey assessed respondents’ understanding of MSTB-3 materials, participation in training sessions, and integration of MSTB-3 recommendations into clinical care. Descriptive statistics were used to analyze data and identify trends.

RESULTS: Results indicated that 89% of audiologists were familiar with the MSTB-3, with 60% having participated in one or more training sessions. Of the respondents, 85% reported incorporating parts or all of the MSTB-3 recommendations into their practices and 75% believed it improved standardization of CI evaluations. Clinicians reported using Consonant-Nucleus-Consonant (CNC) word scores for CI candidacy decisions, consistent with MSTB-3 recommendations, but varied in the score criteria used to determine candidacy. Results show a trend toward more streamlined and efficient patient care delivery recommendations.

CONCLUSIONS: The MSTB-3 has facilitated greater consistency in CI evaluation and follow-up care, addressing historical variability in clinical practices. Its evidence-based approach, including streamlined test protocols and user-friendly tools, offers a framework for improved CI access and standardization. Further training and dissemination efforts are recommended to enhance clinicians’ understanding and to address implementation challenges, ultimately advancing the quality of CI services and reducing disparities in care.

PMID:40829022 | DOI:10.1044/2025_AJA-25-00066

Pediatr Infect Dis J. 2025 Aug 6. doi: 10.1097/INF.0000000000004939. Online ahead of print.

ABSTRACT

BACKGROUND: Streptococcus pneumoniae (Spn) and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are important pathogens. We evaluated the frequency and density of Spn in nasopharyngeal samples, frequency of multiple respiratory virus detection, mucosal cytokine/chemokine levels, and mucosal antibody levels to Spn proteins and capsular polysaccharides during SARS-CoV-2 respiratory infections in children.

METHODS: This retrospective study evaluated 222 nasopharyngeal samples collected from children (age 0-18 years) who were tested for SARS-CoV-2 between May 2020 and October 2021. In 111 SARS-CoV-2 positive (+) and 111 SARS-CoV-2 negative (-) samples, we tested for Spn presence and density, 6 viruses (influenza, parainfluenza, respiratory syncytial virus, human rhinovirus, enterovirus and adenoviruses), 9 mucosal cytokine and chemokine levels, mucosal immunoglobulin G (IgG) and IgA antibody levels to Spn PhtD and PcpA proteins and 7 capsular polysaccharides.

RESULTS: Fourteen percent had Spn concurrently present in SARS-CoV-2+ versus 10.6% for SARS-CoV-2-, (not significant). Concurrent SARS-CoV-2 and human rhinovirus detection occurred. Nasopharyngeal cytokine levels in SARS-CoV-2+ samples were not different compared to SARS-CoV-2- samples, except for monocyte chemoattractant protein-1 (higher in SARS-CoV-2+), and not impacted by presence/density of Spn. Nasopharyngeal IgG antibody levels to PhtD and PcpA, and capsular polysaccharide serotypes during SARS-CoV-2+ infections were not different compared to SARS-CoV-2-.

CONCLUSION: Nasopharyngeal Spn detection and density were not different between SARS-CoV-2+ and SARS-CoV-2- samples in children. Concurrent respiratory virus infection was not common. Nasopharyngeal monocyte chemoattractant protein-1 was higher in SARS-CoV-2+ children. Nasopharyngeal IgG antibody levels to 2 Spn proteins and 7 polysaccharide capsule types did not differ between SARS-CoV-2+ and SARS-CoV-2- samples.

PMID:40829009 | DOI:10.1097/INF.0000000000004939

Int J Periodontics Restorative Dent. 2025 Aug 19;0(0):1-27. doi: 10.11607/prd.7814. Online ahead of print.

ABSTRACT

In subepithelial connective tissue graft (SCTG) harvesting, some clinicians prefer to leave the periosteum at the donor site, anticipating faster healing of the palatal wound, though this assumption has not been clinically proven yet. This study aimed to compare early wound healing at palatal donor sites and patient-reported outcome measures (PROMs: pain perception, delayed bleeding and sensation loss) after harvesting SCTG with or without periosteum using the single-incision technique (SIT). Thirty-eight patients were randomly assigned to two groups: SCTG with periosteum (SCTGP+ group) and SCTG without periosteum (SCTGP- group). Assessment of donor site wound healing at one-week post-surgery using modified early healing index (EHI) was the primary outcome of the study and PROMs were the secondary outcomes. Thirty-four patients (17 in each group) were included in final analysis. The mean EHI for SCTGP+ group (2.88 ± 1.22) and for SCTGP- group (2.70 ± 1.10) did not differ significantly (p = 0.661). Palatal flap thickness was found to be negatively correlated with EHI (p < 0.001) and pain (p < 0.05). No statistically significant differences in pain perception were observed between the groups at any time point. None of the patients reported delayed bleeding. Sensation loss recovery was faster in SCTGP+ group with significant difference between the groups only at week 2 (p = 0.026). Within the limitations of our study, harvesting of SCTG with or without periosteum was not found to significantly influence the wound healing and pain perception at palatal donor site.

PMID:40829008 | DOI:10.11607/prd.7814

Traffic Inj Prev. 2025 Aug 19:1-11. doi: 10.1080/15389588.2025.2538725. Online ahead of print.

ABSTRACT

OBJECTIVE: Pre-crash injury risk prediction is crucial for proactive safety measures, while traditional models, which output single-point predictions without explaining the decision reasons, often lack interpretability and reliable uncertainty estimation to reflect potential risk distributions. These drawbacks limit their practical effectiveness in mitigating injury severity. To overcome these limitations, this study develops a novel framework that outputs potential risk distributions and their corresponding probabilities using only pre-crash data, thereby delivering probabilistic outputs with a statistically guaranteed 90% confidence level. By introducing such a framework, we aim to provide a more convincing and interpretable analysis of the injury distribution and its underlying causes in traffic accidents, ultimately offering data-driven guidance for injury mitigation strategies.

METHODS: Data from the National Automotive Sampling System-Crashworthiness Data System and the Crash Investigation Sampling System were used, incorporating 28 pre-crash risk factors. Several machine learning models, including ensemble methods and the deep learning model TabNet, were evaluated. To address the significant class imbalance, particularly the limited number of serious injury cases, various resampling strategies were applied. The core contribution lies in integrating conformal prediction methods, both naive and class-conditional, to generate prediction sets at a 90% confidence level. Model performance was assessed via global evaluation metrics (i.e., f1-score) and serious injury recall, and interpretability was enhanced using explainable machine learning and statistical analysis.

RESULTS: Comparative experiments indicate a nearly 90% prediction coverage and a 70.3% recall rate for serious injuries by proposed framework, which is significantly higher than those reported in related studies. Further model interpretation highlights key risk factors such as intersection relevance, crash type, and speed limits and how they effect injury severity prediction.

CONCLUSIONS: Proposed framework demonstrates significant potential in pre-crash injury risk prediction by introducing conformal prediction techniques to machine learning models. In addition to enhancing predictive performance to nearly 90% prediction coverage and a 70.3% recall rate for serious injuries, this framework also provides enhanced interpretability by quantifying prediction uncertainty and identifying key risk factors. Unlike traditional methods, the framework remains valid under distribution shifts and combines uncertainty estimation with model interpretability. These advantages collectively lay a foundation for developing proactive traffic safety applications and formulating data-driven road safety policies.

PMID:40828994 | DOI:10.1080/15389588.2025.2538725

J Am Acad Orthop Surg Glob Res Rev. 2025 Aug 19;9(8). doi: 10.5435/JAAOSGlobal-D-25-00002. eCollection 2025 Aug 1.

ABSTRACT

BACKGROUND: Clinical research is an integral component of orthopaedic practice with the purpose of advancing the field and improving patient care. The Journal of Bone and Joint Surgery (JBJS) is a well-respected journal with a high impact factor and considerable influence on clinical practice. To our knowledge, there has been no systematic evaluation highlighting the variety of research published in this journal. Therefore, the purpose of this study was to evaluate trends in characteristics of articles published in JBJS from 2012 to 2022, including type of study, level of evidence, author information, and country of publication.

METHODS: Articles published in JBJS between 2012 and 2022 were retrieved from the JBJS Archives. Title, level of evidence, description of the study as delineated in the abstract, first author degree, number of authors, and country of publication were recorded for each published article.

RESULTS: A total of 2668 articles were published in JBJS from 2012 to 2022. The proportion of preclinical studies published per year significantly decreased (P = 0.0025), whereas no statistically significant change was observed in the proportion of clinical studies (P = 0.34). A significant increase was noted in the proportion of database studies published (P = 0.00012). Studies classified as level II decreased over the study period (P = 0.029), whereas level III increased over the study period (P = 0.034). The average number of authors per article was 6 ± 3 authors with a significantly increasing trend over the study period (P = 0.0043). The proportion of first authors who were MD or equivalent decreased (P = 0.025), whereas first authors who were non-MD or non-PhD equivalent increased (P = 0.0068).

CONCLUSION: The publication trends in JBJS over the past decade demonstrate the changing landscape of orthopaedic research as it aims to address the burden of musculoskeletal injury and disease.

PMID:40828978 | DOI:10.5435/JAAOSGlobal-D-25-00002

Gen Dent. 2025 Sep-Oct;73(5):42-47.

ABSTRACT

The aim of this study was to evaluate the shear bond strength and Adhesive Remnant Index (ARI) of ceramic brackets bonded to enamel using a universal adhesive system free of bisphenol A glycidyl methacrylate (Bis-GMA). A total of 100 bovine incisors were divided into 2 groups (n = 50) that received ceramic brackets (Morelli Ceramic or Ice Clear) bonded after acid etching and application of 1 of 5 adhesive systems (n = 10): Adper Single Bond 2, a conventional adhesive system (control group); Scotchbond Universal Plus, a Bis-GMA-free universal adhesive system; and Single Bond Universal, BeautiBond Xtreme, and BeautiOrtho Bond II, all Bis-GMA-containing universal adhesives. Shear bond strength was tested in a universal testing machine (50-kgf load cell; 0.5 mm/min crosshead speed), and the ARI was analyzed under ×20 magnification. Statistical analysis included a generalized linear model with Fisher exact test, Kruskal-Wallis test with post hoc Dunn test, and Mann-Whitney U test; the significance level was set at 5%. No statistically significant differences in shear bond strength were observed among the adhesive systems (P = 0.7821) or their interactions with bracket type (P = 0.5449). A significant difference was found when bracket types were compared (P < 0.0001), with the Morelli Ceramic bracket groups showing the highest bond strengths regardless of the adhesive system used. A significant association between adhesives and the Morelli Ceramic bracket was observed for the ARI score (P = 0.0018), with 100% of specimens in the Scotchbond Universal Plus adhesive group retaining more than half of the resin on the tooth. The Bis-GMA-free universal adhesive system achieved the highest percentage of adhesive retention on the tooth for both bracket types.

PMID:40828557

Gen Dent. 2025 Sep-Oct;73(5):36-40.

ABSTRACT

Nonodontogenic cysts and pseudocysts pose diagnostic challenges due to their similarity to other maxillofacial lesions in clinical and radiographic appearance. However, these lesions are studied less frequently than odontogenic lesions. This retrospective cross-sectional study aimed to evaluate the frequencies and characteristics of nonodontogenic lesions in an Iranian population over a 20-year period. Archived records of 7036 patients referred to the Department of Oral and Maxillofacial Pathology, Shahid Beheshti University Faculty of Dentistry, Tehran, were reviewed. Data on the age and sex of the patients and the type, clinical and radiographic features, and histopathologic diagnoses of the lesions were collected. Statistical analyses included Fisher exact, Kruskal-Wallis, and chi-square tests, and a value of P < 0.05 was considered statistically significant. Nonodontogenic cysts were found in 0.5% of all referred patients, while pseudocysts were identified in 2.6%. After a review of records, 218 patients with a confirmed diagnosis of oral pseudocysts or nonodontogenic cysts were included in a more detailed analysis. Mucocele was the most common lesion (63.8%), followed by simple bone cyst (13.8%) and nasopalatine duct cyst (11.9%). The mean (SD) age of these patients was 30.5 (15.7) years, and 53.7% of all the lesions occurred in men. Statistically significant relationships were observed between cyst type and sex (P = 0.001; Fisher exact test), age (P < 0.001; Kruskal-Wallis test), and location (P < 0.001; chi-square test). Most pseudocysts occurred on the lower lip, while nonodontogenic cysts and intraosseous pseudocysts were predominantly found in the maxilla and mandible, respectively. The results of this study highlight the varied demographics and clinical and radiographic presentations of nonodontogenic cysts and pseudocysts, emphasizing the need for thorough radiographic and histopathologic analyses to guide appropriate treatment strategies.

PMID:40828556

Gen Dent. 2025 Sep-Oct;73(5):28-34.

ABSTRACT

Periodontitis is an inflammatory destructive condition influenced by obesity and type 2 diabetes mellitus (T2DM). Apelin, a bioactive peptide, is linked to periodontitis, obesity, and T2DM. This study aimed to investigate apelin levels in individuals with periodontitis who are affected by obesity and T2DM. This cross-sectional observational study included 84 participants categorized into 3 main groups of 24 patients based on their periodontal status, body mass index (BMI), and glycated hemoglobin (HbA_1c) levels. Group 1 comprised systemically healthy participants, group 2 comprised individuals with obesity (BMI of 30.0 to 39.0 kg/m2), and group 3 comprised individuals with both obesity and T2DM (HbA_1c of 6.5% to 8.5%). Each group was subcategorized based on the presence or absence of chronic periodontitis (CP), resulting in 6 subgroups with 14 participants each. The clinical parameters assessed included the Sulcus Bleeding Index (SBI), probing depth (PD), clinical attachment loss (CAL), BMI, and HbA_1c level. Apelin levels in serum and saliva were quantified using enzyme-linked immunosorbent assay. Data were analyzed using 1-way analysis of variance and independent samples t test. Pearson correlation coefficients were calculated to assess relationships between different parameters. Within groups, individuals with CP had lower serum and salivary levels of apelin than those without CP, and the differences were statistically significant except in the case of salivary levels in patients with obesity (P < 0.05). Individuals with obesity, as well as those with both T2DM and obesity, had elevated levels of serum apelin compared with systemically healthy individuals. A significant negative correlation was observed between serum apelin and periodontal parameters (SBI, PD, and CAL) in specific subgroups. Apelin could be a valuable biomarker for evaluating periodontal disease affected by obesity and T2DM. However, further longitudinal research with a larger patient sample is needed. Trial registration: Clinical Trials Registry – India No. CTRI/2019/02/017522.

PMID:40828555